Laparoscopic management of ectopic pregnancy: An observational study from North Kashmir

Background: With advancements in field of minimally invasive surgery, increasing number of patients with ectopic pregnancy (EP) can be managed laparoscopically. Aims and Objective: To evaluates our experience of laparoscopic management of ectopic pregnancy in terms of its safety and efficacy. This is an observational study conducted over a period of seven years at Guru Multi-specialty Hospital Sopore, Kashmir, India. Materials and Methods: A total of 84 patients with EP were included in the study. The diagnosis was made by detailed history, clinical examination, βHCG assay, abdominal and transvaginal ultrasonography. All patients underwent laparoscopic salpingectomy or salpingostomy depending on the clinical scenario. The outcome was analysed in terms of details of the procedure, mean operative time, post-operative VAS score (0-10), complications, hospital stay and subsequent fertility. Histopathological examination of the resected fallopian tubes was also evaluated. Statistical analysis was done as a prospective sample survey analyzing percentage and mean values. Results: Sixty-one patients had chronic ectopic while 23 presented acutely. Seventy-seven (91.66%) patients were diagnosed by clinical, laboratory and sonographic modalities while 7 (14.17%) required diagnostic laparoscopy for confirmation. Ampulla was the site of EP in 75% of cases. Ruptured fallopian tubes were found in 20 (86.95%) and 9 (14.75%) patients who presented with acute and chronic ectopic respectively. The patients with chronic ectopic were managed with laparoscopic salpingectomy and laparoscopic salpingostomy in 45 (73.77%) and 16 (26.22%) patients respectively. Patients with acute ectopic were underwent laparoscopic salpingectomy in 18 (78.26%) and salpingostomy in another 5 (21.73%) cases. The operative time was longer in patients with chronic ectopic ranging between 55-135 minutes. A total of five (5.95%) patients required blood transfusions. One each case of chronic and acute ectopic required conversion to open surgery. Histopathological examination of salpingectomy specimen revealed chronic salpingitis was seen in 39.68% of the cases. On follow-up, a total of 18 (29.5%) and 9 (39.13%) patients conceived within a year and another 5 (8.19%) and 2 (8.69%) did so between 1-2 years who presented with chronic and acute ectopic respectively. Conclusions: Laparoscopic approach in treatment of EP is safe and feasible irrespective of the type of presentation with all advantages of minimal access surgery and greatly reduced morbidity.